Endoscopy band with sigmoid support apparatus

ABSTRACT

An endoscopy sigmoid support apparatus that includes a primary wrap sized for placement around a subject&#39;s lower abdomen. A closing mechanism is provided at the end of the primary wrap to secure the primary wrap around the abdomen of the subject by attaching a first end of the primary wrap to a second portion of the primary wrap. A strap extends from the primary wrap and is configured to extend across at least a portion of the primary wrap and to fasten to a third portion of the primary wrap to adjust the amount of pressure applied by the endoscopy sigmoid support apparatus.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.15/256,019, entitled “METHOD AND APPARATUS FOR ENHANCED VISUALIZATIONDURING ENDOSCOPY,” and filed on Sep. 2, 2016, which is acontinuation-in-part of U.S. application Ser. No. 13/344,715, entitled“METHOD AND APPARATUS FOR TENSILE COLONOSCOPY COMPRESSION,” and filed onJan. 6, 2012, and U.S. application Ser. No. 14/575,860, entitled“ENDOSCOPY BAND WITH SIGMOID SUPPORT APPARATUS,” and filed on Dec. 18,2014, which claims the benefit of U.S. Provisional Application Ser. No.61/917,469, entitled “COLONOSCOPY BAND WITH SIGMOID SPLINT” and filed onDec. 18, 2013, and U.S. Provisional Application Ser. No. 61/944,658entitled “ENDOSCOPY BAND WITH SIGMOID SUPPORT APPARATUS” and filed onFeb. 26, 2014, and claims the benefit of priority of U.S. ProvisionalApplication No. 62/214,747, entitled “IMPROVED BOWEL STABILITY ANDENHANCED VISUALIZATION DURING ENDOSCOPY” and filed on Sep. 4, 2015, theentire contents of each of which is expressly incorporated by referenceherein in its entirety.

BACKGROUND

A colonoscopy is an examination of the large intestine or colon throughthe use of a colonoscope. A colonoscope is a flexible, tube-likeinspection device having a camera at its end. Colonoscopies areperformed for a variety of medical reasons including detection ofinflamed tissue, ulcers, abnormal growths or polyps, and colorectalcancer. Colonoscopy as a screening tool to detect colorectal cancer hasincreased significantly since 2000.

During a colonoscopy, a colonoscope is inserted into a patient's rectumand then advanced to the beginning of the colon (an area known as thececum) in order to examine the lining of the large intestine. Theefficiency and accuracy of this procedure is largely dependent on theease with which the colonoscope can be advanced. During the procedure,the colon may become over-distended or flopped in unnatural directionscreating loops that hinder the advancement of the colonoscope andresulting in patient discomfort, longer examination times, andpotentially inaccurate or incomplete screenings.

Currently, the difficulty in advancing the scope has been addressed byutilizing a surgical technician to manually support the patient's colonwith pressure. This is time-consuming and dependent on the particularsurgical assistant's strength, technique, and endurance, as well astraining. Another way to apply differential pressure, particularly inlarger patients, is to roll the patient from the left side to a supineor to a prone position. Often this is not an easy task with a sedatedpatient.

SUMMARY

In an aspect of the disclosure, a method and apparatus for applyingpressure to the abdomen of a patient is provided to ease the passage ofan endoscope during procedures used to examine the bowels includingcolonoscopy, sigmoidoscopy, and enteroscopy. Aspects presented hereinexert both broad, uniform lower abdominal pressure as well asadditional, location-specific pressure upon the sigmoid colon for thepurposes of preventing and reducing the complication known as looping,eliminating the need for the application of manual pressure, improvingpatient safety, comfort, and satisfaction, and preventingmusculoskeletal injury to endoscopy healthcare providers.

Additional advantages and novel features of aspects of the presentinvention will be set forth in part in the description that follows, andin part will become more apparent to those skilled in the art uponexamination of the following or upon learning by practice thereof.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a schematic view of a colon with an endoscope (also known asa colonoscope for colonoscopy procedures) partially inserted therein;

FIG. 1B is a schematic view of a colon in which a sigmoid loop hasdeveloped due to an attempt to advance the endoscope against anunsupported colon wall;

FIG. 1C is a schematic view of a colon showing the application of manualpressure to the colon to facilitate insertion of an endoscope;

FIG. 2A is a schematic view of the performance of a sigmoidoscopy;

FIG. 2B is a schematic view of the performance of a retrogradeenteroscopy;

FIG. 3A is a perspective view of one method to apply manual pressureduring a colonoscopy;

FIG. 3B is a perspective view of a second method used to apply manualpressure;

FIG. 3C is a perspective view of a third method used to apply manualpressure;

FIG. 4 is a perspective view of an unfastened endoscopy band device withsigmoid support apparatus, in accordance with aspects of the presentinvention.

FIG. 5 is a perspective view of a fastened endoscopy band device withsigmoid support apparatus, in accordance with aspects of the presentinvention;

FIG. 6 is an overhead perspective view of the exterior side of theendoscopy band device with sigmoid support apparatus, in accordance withaspects of the present invention;

FIG. 7 depicts the same device FIG. 4 , with the exception that in FIG.5 , the long secondary appendage attached to the primary band is foldedover to show its handle;

FIG. 8 is an overhead perspective view of the interior side of theendoscopy band device with sigmoid support apparatus, in accordance withaspects of the present invention;

FIG. 9 is an angled overhead perspective view of the interior side ofthe endoscopy band device with sigmoid support apparatus, in accordancewith aspects of the present invention;

FIG. 10 is a schematic view of the target area for sigmoid compressionas well as the anatomical features, particularly the left hip, pelvis,and pubic bones, that could impede the ability of an insert to compressthe sigmoid colon if the insert is too large or improperly designed, inaccordance with aspects of the present invention;

FIG. 11 is a schematic view of the colon, and specifically of theapplication of pressure to the sigmoid colon by a non-tapered insert(drawing on left) versus tapered insert (drawing on right), inaccordance with aspects of the present invention. The non-tapered insertis hindering the advancement of the colonoscope;

FIG. 12 is an illustration to show how the level of sigmoid compressionexerted by the device during the procedure may be adjusted, inaccordance with aspects of the present invention;

FIG. 13 is an illustration of a patient lying in the left lateraldecubitus position with the device secured around his lower abdomen, inaccordance with aspects of the present invention;

FIG. 14 is a schematic view of a mechanism for indicating that theprimary wrap or secondary strap is sufficiently fastened, in accordancewith aspects of the present invention, and includes a non-elastic stripwith windows attached to the exterior of the band, and in which icons orimages become visible once the device is sufficiently fastened;

FIG. 15 is a schematic view of a mechanism for indicating that theprimary wrap or secondary strap is sufficiently fastened, in accordancewith aspects of the present invention, and includes an image or logo onthe exterior side of the primary wrap needing to be stretched anddistorted until the image on the wrap matches the image depicted in theuser instructions. Matching of the images indicates that the device isproperly fastened.

FIG. 16 is a perspective view of an unfastened endoscopy band devicewith a sigmoid support apparatus, in accordance with aspects of thepresent invention, the device comprising an elastic secondary strapcapable of retaining tension and exerting directed force to the sigmoidcolon when stretched and fastened to the primary wrap.

FIG. 17 is a perspective view of the endoscopy band device depicted inFIG. 16 as it appears when applied to a patient, in accordance withaspects of the present invention, shown while the patient lies in theleft lateral decubitus position.

FIG. 18 is a schematic view of an endoscopy band device that includes apouch on its interior side that can be used to hold heating pads andmaterials that provide the patient warmth and comfort, in accordancewith aspects of the present invention.

FIG. 19 is a schematic view of the endoscopy band device described inFIG. 18 , with a rectangular heating pad inserted into the pouch, inaccordance with aspects of the present invention.

FIG. 20 is a schematic view of a disposable, removable cover for thehook strip on the inside of the primary wrap, in accordance with aspectsof the present invention. The depiction on the left shows the coverapplied to the hook strip, and the depiction on the right shows thecover removed in preparation for use.

FIG. 21 is a schematic view of a disposable, removable cover for thehook strip on the secondary strap, in accordance with aspects of thepresent invention. The depiction on the left shows the cover applied tothe hook strip, and the depiction on the right shows the cover removedin preparation for use.

FIG. 22 is a perspective view of an endoscopy band device with a sigmoidsupport apparatus, comprising a detachable secondary strap withfastening mechanisms on each end that allow the secondary strap to bestretched along and secured to the exterior of the primary wrap in orderto generate additional, location-specific compression, in accordancewith aspects of the present invention. The three illustrations in FIG.22 demonstrate the method of use of the apparatus.

FIG. 23 is a perspective view of the operation of the endoscopy banddevice and detachable secondary strap depicted in FIG. 22 when theapparatus is used in conjunction with an insert as a means to providefocused compression and support, in accordance with aspects of thepresent invention.

FIG. 24 is a perspective view of an endoscopy band device and insert,with the band comprising a strap capable of retaining tension whenstretched, with fastening mechanisms on each end that allow the strap tobe safely, comfortably, and firmly secured or adhered to the patient,with the strap passing over top of the insert, such that when the strapis secured, the insert is forced into the patient's body, in accordancewith aspects of the present invention. The three illustrations in FIG.24 demonstrate the method of use of the invention, applied while thepatient is undergoing colonoscopy and lies in the left lateral decubitusposition.

FIG. 25 is a schematic perspective of the sigmoid colon and threeadditional anatomical locations (splenic flexure, transverse colon, andhepatic flexure) where looping is known to occur and where theapplication of various aspects of the invention could facilitate andimprove the procedure.

FIG. 26 illustrates aspects of a method for applying pressure andsupport to a patient's abdomen during advancement of an endoscope duringan endoscopy type procedure, in accordance with aspects of the presentinvention.

DETAILED DESCRIPTION

The detailed description set forth below in connection with the appendeddrawings is intended as a description of various configurations and isnot intended to represent the only configurations in which the conceptsdescribed herein may be practiced.

The detailed description includes specific details for the purpose ofproviding a thorough understanding of various concepts. However, it willbe apparent to those skilled in the art that these concepts may bepracticed without these specific details. In some instances, well knownstructures and components are shown in block diagram form in order toavoid obscuring such concepts.

Aspects presented herein comprise a primary abdominal wrap that issecured around the lower abdomen of the patient. Additional aspects mayinclude any of a secondary strap and a shaped insert that providedirected force and support to the sigmoid colon. When the device issecurely fastened, the secondary strap, the insert, or both, may bepushed, pulled, or otherwise pressed into the body in a manner thatserves to support or ‘splint’ the sigmoid colon.

Referring first to FIGS. 1A-C, there is shown in schematic form thesequence of steps of colonoscopy. In FIG. 1A, a colonoscope 2 isinserted into the patient's rectum and advanced forward through thelength of the colon. As the operator passes the colonoscope through thesigmoid region of the colon 4, it often becomes impinged and causesdistention and looping of the anatomy as shown in FIG. 1B. This causesdiscomfort to the patient and increases the time required for thecolonoscopy. Additionally, in order to reduce the distended or loopedarea, the application of manual pressure to abdomen of the patient isoften required. This pressure is generally applied by a nurse orsurgical assistant as shown in FIG. 1C.

Referring to FIGS. 2A-B, there are shown in schematic form depictions ofsigmoidoscopy and retrograde enteroscopy procedures, respectively. Thesefigures are included to demonstrate the similarity between colonoscopyand these two additional endoscopic procedures. Sigmoidoscopy is anexamination of only the lower part of the colon, from the anus to thedescending colon. Thus, in FIG. 2A, an endoscope 20 is shown onlyinserted into the lower part of the colon Enteroscopy is an examinationof the small bowel. During retrograde enteroscopy, an endoscope 20 isinserted in the anus and passed through the colon and the cecum and intothe small bowel. Successfully navigating the loop-prone sigmoid regionis necessary to complete both sigmoidoscopy and retrograde enteroscopyand thus application of the invention should help facilitate colonoscopyas well as sigmoidoscopy and retrograde enteroscopy.

Many patients undergo colonoscopy while placed in the left lateraldecubitus position on the stretcher or operating table. FIGS. 3A-C 6-8illustrate common methods used to deploy manual abdominal pressure whenthe patient is in this position. Additional information about the use ofsuch manual pressure can be found in Prechel J A, Hucke R. Safe andeffective abdominal pressure during colonoscopy: forearm versus openhand technique. Gastroenterol Nurs 2009;32:27-30; quiz 31-2, the entirecontents of which are incorporated herein by reference. Anotherfrequently used method is for the nurse or assistant to reach over thepatient from the opposite side of the table and to deploy pressure byplacing their hands against the patient's sigmoid colon and then leaningbackwards, using their bodyweight for leverage to exert force. Whilethese methods are generally effective at generating pressure, they havealso been identified as a causative factor for the high rate ofwork-related injuries among endoscopy nurses and staff. Physiciansperforming colonoscopy suffer work-related musculoskeletal injury at aparticularly high-rate as well. The most frequent site of physicianinjury is the right upper extremity which experiences peak torque forceswhen while operators are attempting to advance the scope through (alooping) sigmoid colon. Additional details can be found in Spanarkel M,Hathorn J P. Looping During Colonoscopy: A Major, Implied Cause ofInjury Among Endoscopy Healthcare Providers and a Proposed Solution,2013, the entire contents of which are incorporated herein by reference.

As depicted in FIG. 4 , the device 8 may comprise a primary elongatedband or wrap 10 of sufficient length for placement around a patient'slower abdomen. A closing mechanism 12 may be provided at the end of theprimary band to secure the device around the patient so that it providesthe desired amount of broad support and compression. A handle 14 may besewn onto the exterior of one or both ends of the primary wrap to assistin fastening and closure. Aspects may include, an insert 16 attached tothe primary wrap 10 or used in conjunction with the primary wrap 10 toprovide directed force to the sigmoid colon.

The primary wrap 10 preferably has a circumferential length betweenapproximately 15 and 75 inches in order to accommodate varying abdominalgirths in patients. The preferred width of the primary wrap 10 isbetween 6 and 10 inches, although variations having widths of between 3and 20 inches may be used depending on the size of the patient and toaccommodate special circumstances such as an abdominal hernia or a largepannus. For example, the primary wrap may be configured to have a widththat allows it to be fastened around the patient's lower abdomen withthe upper edge of the wrap just below the umbilicus and the bottom edgeof the wrap along or close to the pubic line. The width of the primarywrap may be selected so as not to be so large that the upper edgeconceals the umbilicus and additional areas of the abdomen above theumbilicus. This configuration may be made in order to avoid pressure onthe diaphragm or stomach, as pressure on the diaphragm and stomachduring colonoscopy can increase the risk of oxygen deprivation andaspiration events, respectively, due to the fact that the patient isgenerally sedated during the procedure. The primary wrap 10 maycomprise, entirely or in part, a flexible, bio-compatible foam, rubber,neoprene, polyester, nylon, non-woven or woven fabric, mesh fabric,synthetic fabric, microfiber fabric, silicon or vinyl plastic, or anyother materials generally known to be used in medical fabrics and goods.The primary wrap 10 may be composed of both elastic and inelasticmaterials.

For the primary wrap to provide appropriate general compression andsupport, it may be important that the wrap remain flat against the bodywhen fastened around the abdomen. This is notable because certainmaterials and designs have a tendency to roll-up when stretched orwrapped around the abdomen, particularly when the device is beingapplied to patients with a large pannus. To prevent roll-up fromoccurring, aspects of the invention may include reinforcements to ensurethat the primary abdominal wrap remains flat against the body when usedin patients of varying body sizes. This may be accomplished by theapplication of serge stitching along the edges of the primary abdominalband.

Next, the primary wrap may also accommodate an insert or attachment thatprovides specific support to the sigmoid colon. The insert may be heldagainst the patient's body by a nurse or assistant, and then the primarywrap be fastened around the patient's abdomen and overtop of the insert.This causes the insert to be positioned between the patient's abdomenand the wrap. The wrap helps to maintain the insert at the desiredplacement and applies pressure to the insert. Alternately, the insertmay be attached to the primary wrap by an adhesive, Velcro, or magnetswhile the primary wrap is fastened. In as aspect, there may be a pouchsewn or otherwise attached to the primary wrap into which the insert maybe placed. The insert may also be embedded in the wrap. Such a pouch maybe accessible on the interior, exterior, or both sides of the primarywrap, providing the user the option to add the insert to the primarywrap when deemed necessary. In an alternative embodiment, the insert maybe sewn or attached into or onto the primary wrap during manufacturingand in this case may be a non-removable, inherent product feature. Inother aspects, the actual insert may be incorporated into the primarywrap during manufacturing, and certain appendages may emerge or extendfrom the insert or the pouch in which the insert is placed. Theseappendages may be used, e.g., to facilitate the measurement of the forcegenerated by the insert upon the patient's abdomen, the monitoring ofvital signs, or the capture of other data relevant to the patient'shealth and safety.

The insert may comprise materials that, when pushed, pulled, orotherwise pressed against the patient's abdomen, are able to providemoderate to firm direct force to the sigmoid colon, without causingdiscomfort or pain for the patient or impeding the colonoscopy procedurein any way. In one example, the insert may comprise a firm foammaterial. In another example, the insert may comprise a semi-flexibleplastic, in a third, a semi-flexible silicone composite, and in afourth, an inflatable plastic or composite air bladder. The insert mayadditionally comprise paper, rubber, neoprene, or fabric, or acombination of any of these materials or those listed in the previoussentence, and also in conjunction with a hard object around which thesematerials are wrapped. An important aspect of the composition of theinsert may be that, when it is compressed into the abdomen, it be firmenough to exert counter-pressure that is sufficient to ‘splint’ thesigmoid colon and facilitate the passage of the scope, but flexibleenough that in providing counter-pressure, it does not hinder thepassage of the scope instead.

Another important element of the insert may be its size. While theinsert used in the invention may vary to accommodate differing bodytypes and sizes, any insert used may be of a size that, when positionedover the sigmoid colon, is capable of being compressed into the leftlower quadrant of the abdomen generally, and the sigmoid colonspecifically, without it being impeded by any other anatomical feature.Relevant anatomical features that may be accounted for include the leftpelvis and hip. FIG. 10 depicts an example target area on the body forcompression, with the hashed-area in the drawing indicating theanatomical features that might impede the insert in compressing thesigmoid colon if the size of the insert is too large.

Another important aspect of the insert may be the shape of the insert.The insert shape may be configured to provide firm pressure to thesigmoid colon without pinching the colon or compressing the lumen in away that impedes the advancement of the colonoscope. Aspects presentedherein address this concern by tapering the edges of the insert toreduce the likelihood of the insert pinching or closing of the colonwhen compressed by the device. In one embodiment, the shape of theinsert may approximately resemble the shape of a small souvenirfootball. When deployed, this insert may be placed in either ahorizontal or vertical orientation. FIG. 11 illustrates an exampletapered insert 1102, placed in a vertical orientation, alongside anexample of a non-tapered insert 1104 in order to illustrate thepotential for the non-tapered insert to pinch the colon and hinder theadvancement of the scope. In another example, the shape of the insertmay resemble a semi-hemisphere, with the flat side of the insert placedagainst the wrap and the circular side of the insert held against andpressed into the patient's sigmoid colon. An example of asemi-hemisphere insert 16 is illustrated in FIGS. 8 and 9 .

Additionally, the insert may offer additional functionality beyondapplying force to the sigmoid colon. Through testing, a standard may bedeveloped that identifies and recommends the optimal amount or range offorce needed to optimally support the colon in various patient groups.Accordingly, having some type of force measurement system built into theinsert may be a natural way to provide device operators with knowledgeregarding the amount of force they are exerting on the patient's sigmoidcolon. Having such knowledge could improve the safety, consistency, andeffectiveness of the device and the application of pressure during acolonoscopy generally.

There are several ways in which the insert may be configured to measureforce. In one aspect, springs may be built into the insert that, whencompressed, render a force output on a small, mechanical display. Thismay function in a manner similar to a non-digital bathroom scale. Thedisplay may be positioned in a location where it can be easily read bythe physician, nurse, or assistant.

In another aspect, the pouch, or exterior portion of the wrap where thepouch is located, or both, may be made of a transparent material thatallows for the scale to be read. For example, the scale may be builtinto the insert on the side opposite the patient.

In another aspect, load cells that provide a force output to a digitalscale may be built into the insert, and may be powered by eitherinsertable, rechargeable, or finite-use batteries incorporated into theinsert during manufacturing.

Another aspect may be designed to reduce complexity, by establishingoptimal pressure standards through testing. Once optimal pressurestandards are identified, the insert may be designed to render a simplebinary or ternary output indicating the relationship of the pressurecurrently applied to that of the identified optimal pressure, e.g., thatthe pressure applied is not enough, too much, or correct.

In another aspect, an air bladder may be incorporated into the insertfor facilitating force measurement. In this example, the air bladderinside the insert may include a protruding tube that extends outside ofthe insert. The tube may be capable of being connected to a tool formeasuring pressure such as a sphygmomanometer. For example, the user maymeasure the baseline pressure of the air bladder prior to the insertbeing compressed, and then may be able to calculate the force applied tothe patient by comparing the difference between the observed pressureand the baseline value.

Aspects described herein may be designed to provide broad lowerabdominal support, and additional direct force to the sigmoid colon of apatient undergoing colonoscopy.

Additional aspects include a device configured to provide directed forceto the sigmoid colon. This may involve, e.g., the incorporation ofvarious different features. A first example may include a primaryabdominal band comprising two or more sections that vary in materialtype. In one example, as depicted in FIG. 9 , two sections—one larger40, and one smaller 41—of the primary abdominal band 10 may be composedof a flexible, elastic or semi-elastic, medium-thickness, latex-freeneoprene with thin polyester or nylon glued to its interior and exteriorsides. Among others, this material may be capable of providing broad,firm, yet comfortable support to the patient's abdominal region. A thirdsection 42 of the primary wrap 10 may comprise a relatively inelasticmaterial, such as a woven fabric. The inelastic section 42 may beprovided at the location into which or under which the insert is placed.Upon deployment of the device, the inelastic section 42 may bepositioned in the patient's lower left abdominal quadrant, over thesigmoid region. The primary wrap 10 may be placed around the patient'slower abdomen and secured using a closing mechanism 12 consisting of astrip of VELCRO® or hook material 13 placed on the interior of the wrap10 close to the location of the handle 14 on the opposite side. Thishook strip 13 may be fastened to the exterior side of the opposite endof the primary wrap 10.

The edges of the hook strip 13 might not extend to the edges of theprimary wrap 10. This construction may be designed to minimize thechance that the hook strip 13 comes into contact with the patient'sskin, or with the gloves of the nurse or assistant deploying the device,as there is a small but known risk of VELCRO®, or a hook and pilematerial, being capable of tearing medical gloves.

An additional feature designed to reduce the likelihood of patient andprovider contact with the hook material is depicted in FIG. 21 . Inaspects incorporating this feature, prior to the device being packaged,a thin layer of material 90 may be applied to hook strips that areincorporated into the device. This layer 90 may comprise, e.g., paper,plastic, fabric, silicon, or any other biocompatible material typicallyused in healthcare products. Additionally, the layer 90 may be lightlyadhered to the hook strips so that it remains in place—until it iseasily removed and disposed of by the end user just prior to thedevice's application on the patient. This feature may be especiallyhelpful in examples that include a secondary strap, such as the devicedepicted in FIG. 16 . This is because in such devices, it may beimportant that the secondary strap 72 remain unfastened until theprimary wrap 10 is fastened and properly positioned. Having a layer 90covering the hook strip 75 on the secondary strap 72 helps to ensurethat the secondary strap will not be accidentally fastened while theuser is securing the primary wrap 10 around the patient's abdomen.

In one example, there are one or more appendages on the exterior of theprimary wrap that facilitate the application of additional directedforce by the insert, e.g., without requiring adjustment of the primarywrap. The appendages may comprise one, or several, straps attached onone side to the edge or edges of non-elastic section. On the unattachedend of these straps, there may be a closing mechanism. The straps may bepulled horizontally along the exterior of the primary wrap, and fastenedusing the closing mechanism securely enough to maintain tension. Whenthese straps are secured to the inelastic section, the tension generatedby fastening these straps causes additional compression of the inelasticsection and the insert being toward the body.

As depicted in FIGS. 4-7 , a short strap 44 may be attached along itsown right vertical edge to the right vertical edge of the inelasticsection 42. The strap 44 may lay to the left, and extends just past theleft vertical edge of the inelastic section 42. On the end of the strap44 not attached to the inelastic section 42, there may be a small hinge46. There may also be another, longer strap 48 attached along the largerneoprene section 40 of the exterior primary wrap 10. The longer strap 48may be positioned approximately midway along section 40. Once theprimary wrap has been fastened by its closing mechanism 12, this strap48 may be passed across the closing mechanism 12 of the primary wrap 10,through the hinge 46 on the short strap 44, and then doubled-back andpulled toward the direction from which it came. At the unattached end ofthe long strap 48, there may be a patch of VELCRO® or hook material 50(visible in FIG. 4, 6 ), and on the opposite of the side of this end ofthe long strap 48, a small handle 52 (visible in FIGS. 5, 7 .) Once thestrap 48 passes through the hinge 46, this strap may be tightened andfastened by the nurse or assistant to exert additional, directed forceto the sigmoid colon through the insert 16. As depicted in FIG. 12 ,this aspect may allow nurses and technicians to easily adjust the forceon the sigmoid colon from the location in the procedure or operatingroom in which they are most often positioned during a colonoscopy, Itadditionally eliminates the need for the nurse or assistant to providemanual abdominal compression, thereby reducing their risk ofmusculoskeletal injury. Additionally, this example allows for the deviceto be quickly and easily removed should the need arise.

Thus, as illustrated in FIG. 12 , the strap is coupled, e.g., sewn, to aportion of the wrap that is configured for placement over a left side ofthe patient's lower abdomen. The strap is pulled from left to right,e.g., pulled across lower abdomen and left lower abdominal quadrant fromleft side of body towards right side of body. This can be helpfulbecause the patient typically lies on their left side during theprocedure. Because the strap pulls from left to right across the lowerabdomen, additional leverage and compression may be generated by thepatient's body when the strap is in place. As the strap goes from leftto right also allows the level of compression generated by the device tobe easily adjusted during the procedure, e.g., while the patient islying on their left side.

Thus, the strap is connected to the wrap in a manner that it extendsunder the patient during a procedure. The strap can then be pulledopposite the portion under the patient in order to use the weight of thepatient's body to adjust the compression applied by the strap.

The wrap may be re-usable and washable, re-usable with a finite numberof uses, and/or disposable and designed for single-use only. Inaddition, aspects may comprise a combination of re-usable and disposableparts. In disposable aspects, features may be incorporated into thedevice that indicate whether the product has been previously used. Thesefeatures may include materials that change color, shape, size, orcomposition after the product has been used once. Additional featuresmay include coloring the exterior of the wrap white or another lightcolor so that evidence of use and soiling is obvious.

Other aspects might not use the insert to indicate, gauge, or measurethe amount of force being generated upon the sigmoid colon or the lowerabdomen. Certain aspects may instead utilize mechanical and visualindicators to inform device operators how or where to fasten theinvention to exert optimal pressure to facilitate the procedure. Severalexamples are depicted in FIGS. 14-15 .

One aspect, illustrated in FIG. 14 incorporates a non-stretchable strip102 with transparent windows 104 attached to the exterior surface of theprimary wrap 10, or alternatively to the exterior surface of a secondarystrap. When the wrap is stretched or fastened sufficiently, visualindicators such as logos 106 may, for example, become visible throughthe transparent windows 104.

Another aspect, illustrated in FIG. 15 may include instructions to theuser 108 to stretch the primary wrap 10, or a secondary strap (notshown) until a visual indicator such as a logo 112 on the exterior ofthe primary wrap 10 is distorted, e.g., stretched, to the point that itlooks like the visual indicator included in the instructions 110. Thematching of the images may be used to indicate to the user that thedevice has been properly fastened.

In another aspect, sensors capable of being stretched may be attached tothe exterior surface of the wrap or secondary strap. These sensors maybe built into a circuit with a small battery and LED light, all of whichmay be sewn into or attached to the wrap. When the sensors arestretched, the resistance in the circuit may be altered. The circuit maybe designed to light the LED when the desired amount of stretch andresistance has been achieved.

Additional example aspects of the device are depicted in FIGS. 16-17 ,and may include a primary wrap 10, with a closing mechanism 12, and ahandle 14 to assist in fastening the primary wrap around the patient'slower abdomen. The device may also include a secondary strap 72 attachedto the exterior side 78 of the primary wrap 10, with a closing mechanism74 that allows the strap, e.g., to be fastened to the exterior side 78of the primary wrap 10. In an aspect, the closing mechanism 74 of thesecondary strap 72 may comprise a hook strip 75 on the inside of thesecondary strap 72 that is capable of fastening anywhere along theexterior side 78 of the primary wrap 10—the hook strip 75 on thesecondary strap 72 is visible in FIG. 21 . In this example, the exteriorside 78 of the primary wrap 10 comprises a hook-compatible material towhich the hook strip 75 can be fastened and remain fastened while thesecondary strap is stretched and under tension. The secondary strap 72is constructed of an elastic or semi-elastic material that is capable ofretaining tension when stretched horizontally and fastened to theexterior side 78 of the primary wrap 10 using the closing mechanism 74.The secondary strap 72 may comprise the same or different materials thanthe materials comprised in the primary wrap 10. The secondary strap 72may comprise one or more layers of materials. In an example, thesecondary strap 72 may comprise an elastic strap the entire length ofwhich equals approximately twice the intended length of the secondarystrap 72. In this example, the elastic strap may be doubled-over, andboth ends may be sewn to the exterior 78 of the primary wrap 10 alongthe same vertical line 73, creating the horizontal ‘V’ appearance of thesecondary strap 72 shown in FIG. 16 . Doubling-over the materialcomposing the secondary strap can serve to increase the breadth andforce generated by the secondary strap, while preventing the incurrenceof additional materials costs that would be associated with using ataller, single-layered strap instead. The midpoint of the secondarystrap may be positioned approximately over the patient's lower leftquadrant once it is stretched and fastened.

An insert may or may not be used with this example. Should an insert beused with this embodiment, the insert may be positioned against theexterior side 78 of the primary wrap 10, in the preferred anatomicallocation. Once properly positioned, the secondary strap 72 may then bepassed over the top of the insert, stretched to tension, and fastenedusing the closing mechanism 74. The force exerted upon the insert by thetensioning of secondary strap 72 may serve to press the insert into thebody in manner that allows the insert to successfully splint the sigmoidcolon. Mechanisms for indicating stretch and compression, such as thosedescribed in connection with FIGS. 14 and 15 , may be provided so thatthe device includes a mechanism to visually indicate the magnitude offorce being applied, such as the mark 80 labeled “Logo” which stretchesand deforms when the secondary strap 72 is stretched and fastened. Withthis mechanism, users may compare the deformed mark with a picture orillustration included in the product instructions or packaging todetermine that the device has been applied correctly.

Other aspects may also incorporate a secondary strap to exertadditional, location specific force is depicted in FIGS. 22-23 . Unlikethe embodiment depicted in FIG. 16 , where one-side vertical side of thesecondary strap is affixed to the device, the secondary strap in theembodiment shown by FIGS. 22-23 may be fully detachable from the primarywrap, and may have fastening mechanisms at both ends that allow thestrap to be secured the exterior side of the primary wrap. The secondarystrap in this aspect may be either re-usable or disposable, and may becapable of being stretched and maintaining tension, or may use anothermechanism to exert compressive force, when it is secured to the primaryband. An insert may be used with the detachable secondary strap, asdemonstrated in FIG. 23 . FIG. 24 depicts an example that includes onlyone strap. The strap in this example might not wrap fully around thepatient but instead may be stretched directly about the location on thepatient's body where force is desired. The strap may be equipped withfastening mechanisms on each end, e.g., to allow the strap to adheredirectly to the patient's body. Such a wrap may be used with an insert.The insert may be separate from the strap, or may be affixed to or buildinto the strap. The strap and insert in this embodiment may be eitherre-usable or disposable. Such aspects might be particularly helpful ininstances when unexpected looping occurs, particularly in areas of thebowel less prone to looping. FIG. 25 illustrates schematically how thewrap may be used to address looping at the splenic flexure, in thetransverse colon, or at the hepatic flexure.

Improving patient comfort and reducing complications, both during andfollowing endoscopic procedures is very important. Aspects presentedherein reduce patient discomfort and complications by helping to preventand reduce sigmoid looping, which can be a primary cause of patient painand discomfort.

Patients often become cold or uncomfortably chilled once they changeinto the garments such as hospital gowns typically worn while undergoingan endoscopic procedure. Many patients request and are provided withblankets, and some facilities provide electric heated blankets, orblankets that have been previously warmed. The heated blankets providephysical warmth, but also they tend to relax the patient and relieveanxiety or discomfort the patient may be experiencing. Aspects presentedherein may also help the patient feel warm and comfortable. In FIGS.18-19 , e.g., a primary wrap 10 may be equipped with a pouch 92 that isattached or fastened to the interior side of the primary wrap 10. Thispouch 92 may be capable of accepting and holding in place re-usable ordisposable heating apparatuses, including the rectangular heating pad 94shown in FIG. 19 . FIG. 26 illustrates aspects of a method for applyingpressure and support to a patient's abdomen during advancement of anendoscope during an endoscopy type procedure. At 2602, a primary wrap iswrapped around the lower abdomen of a patient, e.g., approximatelybetween the hips and umbilicus of the patient.

After wrapping the primary wrap about the abdomen of the patient, theprimary wrap is secured by attaching a first end of the primary wrap toa second portion of the primary wrap at 2604.

The amount of compression applied to the abdomen of the patient may beadjusted by pulling a strap extending from the primary wrap across atleast a portion of the primary wrap at 2606 and fastening the strap to athird portion of the primary wrap at 2608. The strap may be coupled to aportion of the primary wrap that is configured for placement over a leftside of the subject's lower abdomen. This allows the patient's own bodyweight to be leveraged in order to adjust the compression provided bythe strap. The strap may be configured to be pulled in a directiontoward a right side of the subject's lower abdomen to adjust the amountof pressure applied by the endoscopy sigmoid support apparatus.

Optionally, an insert may be positioned near a sigmoid region of thepatient at 2610. This may involve placing the insert between the abdomenof the patient and the wrap and/or the strap. The insert may beconfigured to increase the compression applied to the sigmoid region,e.g., as described in connection with FIGS. 4, 5, and 8-11 . In oneexample, the insert may be inserted into a receptacle formed in theprimary wrap and/or the strap.

As another option, the primary wrap may comprise an insert, and theinsert may be positioned over a lower left quadrant of the patient'sabdomen over the sigmoid region prior to securing the primary wrap andadjusting the compression applied to the abdomen. A portion of the wrapand/or the strap may extend over the insert in order to adjust thecompression applied by the insert.

As another option at 2612, the amount of force being applied by theendoscopy sigmoid support apparatus may be measured using a compressionindicator. Among others, the indicator may comprise a gauge formeasuring and indicating the amount of pressure applied to the abdomenof the subject and/or a visual indicator. For example, a strip ofmaterial may be used having at least one transparent window throughwhich a mark or a set of marks can be viewed in order to determine theamount of pressure being applied. In another example, a visual mark maybe provided directly on an elastic portion of the apparatus, and thedeformation of the visual mark may be used to determine an amount ofpressure being applied. An example deformed mark may be provided so thatan operator can compare the example deformed mark to the deformation ofthe visual mark.

The primary wrap may comprise a first elastic portion and a secondelastic portion separated by a relatively inelastic portion, and themethod may include positioning the relatively inelastic portion over asigmoid region of the subject's lower abdomen. One edge of the strap maybe connected to the inelastic portion and a second edge may fasten tothe primary wrap by extending the strap across the inelastic portion toincrease compression at the inelastic portion. A second strap may beprovided that extends from an attachment point on the primary wrap. Forexample, the second strap may be positioned on a side of the wrapopposite the strap. The second strap may be looped through a portion ofthe strap and pulled back toward the attachment point in order to adjustthe compression applied to the subject.

The wrap and/or the strap may fasten using a hook and pile or hook andloop type fastening mechanism. A removable covering may be placed overthe hook portion. Thus, at 2614 or 2616, the removable covering may beremoved after the device is placed around the patient and prior tosecuring either the primary wrap or the strap.

Aspects may further include inserting a heating pad, e.g., into areceptacle within the primary wrap and/or strap.

To additionally enhance patient comfort, certain aspects of theinvention are designed to be single-use, and to remain fastened in placeon the patient following the procedure. This method of application maybe used to reduce the common post-procedure complications of bloatingand abdominal pain caused by bloating. Otherwise known as gaseousdistention, bloating occurs following endoscopy procedures becausephysicians often use compressed air or carbon dioxide to insufflateparts of the bowel that are difficult to see and examine. The gas opensup the area to allow for a more complete visualization, enhancing theefficacy of the procedure. However, the gas also remains in the patientuntil it is either absorbed or expelled. Expulsion is the primary gasremoval mechanism as absorption is a very inefficient process. Gaseousdistention is a primary post-procedure complication and a frequentcomplaint from patients. However when the wrap described herein remainsin place after the procedure, the lower abdominal compression generatedby the device allows the bowel to more rapidly evacuate trapped bydirecting excess gas towards the rectum. As a result, the severity andduration of post-procedure bloating and associated abdominal pain may bereduced.

Example aspects of the present invention have now been described inaccordance with the above advantages. It will be appreciated that theseexamples are merely illustrative of aspects of the present invention.Many variations and modifications will be apparent to those skilled inthe art.

It is understood that the specific order or hierarchy of steps in theprocesses disclosed is an illustration of exemplary approaches. Basedupon design preferences, it is understood that the specific order orhierarchy of steps in the processes may be rearranged. Further, somesteps may be combined or omitted. The accompanying method claims presentelements of the various steps in a sample order, and are not meant to belimited to the specific order or hierarchy presented.

The previous description is provided to enable any person skilled in theart to practice the various aspects described herein. Variousmodifications to these aspects will be readily apparent to those skilledin the art, and the generic principles defined herein may be applied toother aspects. Thus, the claims are not intended to be limited to theaspects shown herein, but is to be accorded the full scope consistentwith the language claims, wherein reference to an element in thesingular is not intended to mean “one and only one” unless specificallyso stated, but rather “one or more.” The word “exemplary” is used hereinto mean “serving as an example, instance, or illustration.” Any aspectdescribed herein as “exemplary” is not necessarily to be construed aspreferred or advantageous over other aspects.” Unless specificallystated otherwise, the term “some” refers to one or more. Combinationssuch as “at least one of A, B, or C,” “at least one of A, B, and C,” and“A, B, C, or any combination thereof” include any combination of A, B,and/or C, and may include multiples of A, multiples of B, or multiplesof C. Specifically, combinations such as “at least one of A, B, or C,”“at least one of A, B, and C,” and “A, B, C, or any combination thereof”may be A only, B only, C only, A and B, A and C, B and C, or A and B andC, where any such combinations may contain one or more member or membersof A, B, or C. All structural and functional equivalents to the elementsof the various aspects described throughout this disclosure that areknown or later come to be known to those of ordinary skill in the artare expressly incorporated herein by reference and are intended to beencompassed by the claims. Moreover, nothing disclosed herein isintended to be dedicated to the public regardless of whether suchdisclosure is explicitly recited in the claims. No claim element is tobe construed as a means plus function unless the element is expresslyrecited using the phrase “means for.”

The invention claimed is:
 1. An endoscopy support apparatus, comprising:a primary elastic wrap comprising a band of elastic material sized forplacement around a subject's lower abdomen and configured to apply aselected degree of constant pressure and support through contraction ofthe band of elastic material across the subject's lower abdomen in orderto facilitate passage of an endoscope; a closing mechanism provided atan end of the primary elastic wrap to secure the primary elastic wraparound the subject's lower abdomen; and an elastic secondary straphaving a first, terminal end fixed to the primary elastic wrap at a leftportion of the primary elastic wrap and configured to stretch left toright across a front abdomen portion of the primary elastic wrap on anexterior side and to removably couple at a second, non-fixed end to theprimary elastic wrap at a non-fixed position to exert additionallocation specific compression to the subject's lower abdomen, wherein anadditional degree of compression through contraction is adjustable basedon a position at which the second, non-fixed end of the elasticsecondary strap is coupled to the primary elastic wrap, wherein theelastic secondary strap comprises a tapered shape that tapers along morethan half of a length of the elastic secondary strap from the first,terminal end to the second, non-fixed end.
 2. The endoscopy supportapparatus of claim 1, wherein the elastic secondary strap comprises thetapered shape that tapers along an entire length of the elasticsecondary strap from the first, terminal end to the second, non-fixedend.
 3. The endoscopy support apparatus of claim 1, further comprising:at least one looped handle positioned at the end of the primary elasticwrap separately from the elastic secondary strap and configured toassist in securing the primary elastic wrap around the subject's lowerabdomen.
 4. The endoscopy support apparatus of claim 1, furthercomprising multiple elastic secondary straps.
 5. The endoscopy supportapparatus of claim 1, wherein the elastic secondary strap comprises: ahook type fastening material configured to removably couple to theprimary elastic wrap at any point along the exterior side of the primaryelastic wrap.
 6. The endoscopy support apparatus of claim 5, wherein thehook type fastening material is configured to removably couple to theprimary elastic wrap using a hook and pile type attachment.
 7. Theendoscopy support apparatus of claim 5, further comprising: a removablecovering applied over the hook type fastening material.
 8. The endoscopysupport apparatus of claim 1, wherein the elastic secondary strapcomprises two fixed portions coupled to the primary elastic wrap along avertical line, and wherein the second, non-fixed end includes a handleand a fastening mechanism at a midpoint that allows the elasticsecondary strap to removably couple to the primary elastic wrap.
 9. Theendoscopy support apparatus of claim 1, further comprising: an insertpositionable between the subject and at least one selected from a groupconsisting of the primary elastic wrap and the elastic secondary strap,wherein the insert is configured to provide directed compression on aregion of the subject's lower abdomen.
 10. The endoscopy supportapparatus of claim 9, further comprising: a receptacle formed on theprimary elastic wrap for receiving the insert.
 11. The endoscopy supportapparatus of claim 9, wherein the insert is attached to the primaryelastic wrap.
 12. The endoscopy support apparatus of claim 9, whereinthe insert comprises at least one of a tapered shape or a rounded shape.13. The endoscopy support apparatus of claim 9, wherein the insert issized to provide the compression on an area surrounding a sigmoid colonof the subject without engaging anatomical features that impede thecompression of the sigmoid colon.
 14. The endoscopy support apparatus ofclaim 9, wherein the primary elastic wrap comprises first elasticportion and a second elastic portion separated by a relatively inelasticportion, wherein the relatively inelastic portion is configured to bepositioned over a sigmoid region of the subject's lower abdomen, andwherein the elastic secondary strap is configured to extend across therelatively inelastic portion.
 15. The endoscopy support apparatus ofclaim 1, further comprising: a visual mark indicator that indicates anamount of force being applied by the endoscopy support apparatus using avisual mark provided on the primary elastic wrap or the elasticsecondary strap of the endoscopy support apparatus.
 16. The endoscopysupport apparatus of claim 15, wherein the visual mark indicatorcomprises a strip of material having at least one transparent window,wherein the visual mark can be viewed through the at least onetransparent window to determine the amount of force being applied. 17.The endoscopy support apparatus of claim 15, wherein the visual markindicator comprises an image or a printed word provided on an elasticportion of the endoscopy support apparatus, wherein a deformation of theimage or the printed word is used to determine the amount of force beingapplied.
 18. The endoscopy support apparatus of claim 1, furthercomprising a feature configured to visually indicate prior use.
 19. Theendoscopy support apparatus of claim 1, further comprising: a receptaclefor receiving a heating pad.
 20. The endoscopy support apparatus ofclaim 1, wherein the elastic secondary strap includes two fixed endsthat are fixed to the primary elastic wrap, and the second, non-fixedend comprises a midpoint between the fixed ends, wherein the two fixedends are spaced to provide the tapered shape to the midpoint at thesecond, non-fixed end.